| What to Do When You've Had a Worksite Accident | |
| Get medical care for your employee | |
| Be ready with the address of a medical facility within your workers' compensation carrier's Medical Provider Network. Take care of your employee first. | |
| Paperwork | |
| 1. Give employee an
"Employee's Claim form for Workers' Comp
Benefits" (DWC-1) within 1 day of your knowledge of incident. (click
highlight for PDF version of form) 2. Call your workers' compensation carrier and report the accident. For State Fund policyholders, the 24 hour toll free number is 1-888-222-3211. File a DWC-1 with your carrier, too. 3. Fill out an Employer's Report of Occupational Injury or Illness, form 5020. You get this from your workers' comp carrier. 4. If the injury was serious or fatal, you must report it to Cal/OSHA immediately. The Redding phone number is 530-224-4743, the Sacramento number is 916-263-2800. 4. Complete a worksite investigation, interview witnesses and keep it with your IIPP. 5. Fill out the Cal/OSHA form 301 Incident Report. Keep it with your IIPP. This is not required of employers of less than 10 employees. |
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| Stay in Touch | |
| Manage the claim: Work with
your claims adjustor to get the claim closed. Stay in touch with your employee: Keep communicating and figure out a way to bring the employee back on modified duty, if necessary. Follow up on how the accident happened and how to avoid it in the future. |
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| Resources | |
|
State Compensation Insurance Fund
Forms: Division of Workers
Comp Division of Workers Compensation Department of Industrial Relations |
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